A few fun days ...

The past few weeks we've had incredibly great weather in San Francisco (and the bay area). Not sure who to credit/blame for this, but we are enjoying it as much as we can. We had a great outing on friday (after school) and Saturday with the kids and a few friends. Friday after school we went to Hotel Nikko swimming pool and swam for some time. I took the opportunity to use the gym and did the elliptical machine for a mile and a stationary bike for a mile. The kids then warmed up in the sauna before we continued on our adventures. We took the powell street cable car and were headed toward ghiradelli square. After China town the cable car goes via Russian Hill (Hyde and Union), which is also the location of Zarzuela, one of our favorites tapas bar. It was early enough that we decided to jump out and have an early dinner with the kids.

The meal (tortilla omelet, patatas bravas, goat cheese in tomato sauce, grilled calamari, crab bisque soup) was quite good along with some excellent sangria. Maya was quite adventurous and tried (and liked) pretty much all the dishes. PJ pushed her boundaries a bit and tried a few more things in addition to her favorite food of bread with olive oil :). It was getting late so we headed back home. The first couple of cable cars were full, we managed to get on the third car and then took the underground to castro where the car was parked.

On saturday we headed to Muir woods to take the kids on a short hike. Our friend trish had an extra credit project out there and hence the outing. The extra credit was a bit lame (she just had to take a photograph and a receipt of the visit along with a short writeup), but we did get a decent hike in. Its quite amazing that even though the place is super crowded at the entrance, most of the crowd does not venture past the second bridge. We made it close to the end of the boardwalk trail with multiple snack stops and visits to big trees along the way. On the return, Tan, Trish, Nick and I took the hillside trail back to the visitor center. Towards the end of the hike, we lost sight of Nick and Trish. Tan was a bit flustered and we split up to find them. Trish and Nick were waiting for us at the entrance and did the wise thing of staying put. Since it was quite a hot day, we decided to head to chrissy field and spent a couple of hours at the beach. I went for a short 20 minute run along the beach to give my knees/muscles some more exercise. Nick and Trish wanted to eat at Cha Cha Cha, so we had an early dinner there. We had a large group so we got a taste of most of the dishes on the menu. Most of the food at C3 is mediocre, but it does have a few excellent dishes (potatoes, cajun shrimp, jerk chicken).

We had a nice long uphill walk back home (helps to get sober from all the sangria) and had a one spoon dessert of yummy salted-malted ice cream from Bi-rite Creamery. The kids (and us) were exhausted at the end of the day. My knee was quite sore and achy which meant i was fast asleep by 8:30 pm (kinda amazing how the body reacts to various things). I've been sleeping much better the past few weeks, but still not as good as I used to. The temperature difference between the two knees is quite amazing (you can literally feel the heat from the fixed knee. this is expected behavior and should slowly disappear as the knee heals)

Anterior Crucial Ligament (ACL) Reconstruction Rehabiliatation Guidelines

(Since i did not find a good physical therapy schedule on the web, i'm typing out what my PT gave me)

These notes are from Health South Doctors Hospital, Alex Lau

Post-Operative Week 1:

• VMO quad sets with biofeedback
• Straight leg raises
• Gentle patellar mobilization/scar mobilization
• Theraband ankle exercises
• EMS especially important if patient unable to initiate quad sets of independent SLR
• Prone extension
• Gastroc/hamstring streching
• Cryotherapy
• Manual/self ROM zero to 90 degrees

Post-Operative Week 2:

• Continue previous treatment
• Isotonic program (hip abduction/adduction, leg curl)
• Mini squats 0 - 30 degrees
  
• Wall slides 0 - 30 degrees
• Posterior tibial glide joint mobilization at 30 degrees and 90 degrees if ROM problem persists especially in ext
• Bicycle ROM 1/2 arcs progressing to full ROM

Post-Operative Week 3:

• KT-1000
• Continue with previous treatment
• Heel walking, toe walking
• Balance/proprioception training on flat terrain
• Reformer single leg press
• PROM/self ROM zero to 120 degrees sitting. Upon obtaining 110 degrees of flexion proceed with prone ROM
• O/C brace and crutches if ambulating without a limp

Post-Operative Week 4-6:

• Continue Isotonic program (hips, hamstrings, leg press)
• Continue with previous program
• Treadmill forward and backward walking
• Step ups
• Trampoline - single leg standing
• Balance board (lateral tilt, A/P tilt)
• Weight shifting (modified lunge to 30 degree flexion: forward, backward, sideways)
• Continue biofeedback for neuromuscular VMO re-education
  
• Aggressive patellar and soft tissue mob, post-tibial glides
• PROM/self ROM zero to 135 degrees seated, prone zero to 120 degrees
• Interval stationary bike program

At the end of 6 weeks, patient should have between zero to 135 degrees ROM, good patellar mobilization. Normal WB and gait. Minimal pain and swelling. Biofeedback can be included in closed chain activities


Post-Operative Weeks 6-12:

• Continue with previous treatment
• Isokinetics limited range (90-45 degrees), high speed above 150 to 180 degrees/sec at 10 weeks (If painfree and no patella femoral problems)
• Isotonic squats - Smith Machine bar weight only (feet forward, tibia perpendicular)
• Lunges
• Stairmaster
• Slideboard
• Sport cord walking (forward, backward, sideways)
• Trampoline (Single leg bouncing, stepping high knee, weight shifting forward, sideways, diagonally)

Patient should obtain full ROM between 8-10 weeks. Self ROM seated and prone should be continued for 6-8 monts to allow full harvest site tissue maturation.

Post-Operative Weeks 12-16:

• Continue with previous program
• Isotonic terminal kne extension, low resistance high repetition
• Theraband slow running low intensity
• Controlled slow forward and backward jogging on level surface
• Trampoline jogging
• Low intensity impact activities (In absence of patella femoral pain or general knee pain. Patient should also have full ROM at this time.) (double leg jumping, sideways jumping, forward jumping, running on spot)
• Functional closed chain evaluation
• At 15-16 weeks, Isokinetic evaluation (In absence of patella femoral pain or general knee pain)

Post-Operative Weeks 16-20:

• Continue with previous program
• Running program if 70% quad stregth per Biodex test and asymptomatic function evaluation. Test speed dependant on sport specfic and symptomatic basis
• Sport specific activities
• Plyometrics medium to high intensity (broad jump, single leg jumping, vertical jumps)
• Agility limits
• Isokinetic evaluation and functional evaluation on a monthly basis until discharge from formal medical care. Patient will be discharged from formal physical therapy with a home program at 20 weeks

ACL Surgery: 3 week report ..

So its been a bit more than 3 weeks since i had my knee 'fixed'. I had my first PT (physical therapy) appointment at the 3 week mark. Seems like I'm progressing quite well and have got a fair amount of flexibility back. Did not lose a lot of muscle strength in the quads / calves since i was not out for too long and have been fairly aggresive on stretching and walking and putting load on it etc. My PT, Brian, gave me a a pretty good post-op exercise worksheet, which i'll put on the next blog post (since i could not find anything good on the web).

I've started taking long walks up and down the hills of San Francisco. Can pretty much go for 90 minutes (with a small coffee break in between) with no significant issues. Also, I can walk as fast as the kids which is a big step forward :) The kids school had a walkathon yesterday. I walked a few laps with the kids and also jogged a bit. Jogging is a bit more difficult, but i suspect it streches the skin and flexes the knee more than walking. So will incorporate this into my daily PT exercises. There is still some amount of swelling around the knee, but this is normal and will be around for the next few months.

Its quite wierd how the knee flexes differently in different directions. Sitting on my bottom, in can pull my knee quite close (125 degrees or so) towards my bottom. However lying on my stomach and trying to bend my knee (hamstring curls), seems like i can just bend my knee a wee bit past the 90 degree mark. mari had a good idea of flexing my toes while doing it, which would get me a few more degrees. Maya helps me out quite a bit and does most of the exercises alongside me and is very curious about what each exercise does etc.

We've been swimming once a week and that seems to help too. Our latest swimming find is Hotel Nikko which has a nice warm pool (86 degrees) and is quite reasonable ($10 / adult, kids are free). This find was due to an excellent blog post in the chronicle. The kids are becoming pretty good at climbing at Mission Cliffs. As an incentive, i've promised to get the chalk bags when they can climb 5.4 and climbing shoes when they climb 5.5. I hope we'll do a lot of outdoor climbing this summer (along with some rafting and lots of biking). I was able to belay the kids with my brace in week 2 and did not need the brace last week. I'm hoping to start climbing in the next few weeks

Vote for Larry Volpe for the Intel tech makeover awards ..

Larry Volpe is an awesome teacher and a long time San Jose ICO volunteer. he's in the running for an Intel tech makeover award. To vote for him click here

Voting closes soon, so do it NOW :)

The Food Exchange

After almost two years of living in Nelson, we learned how to cook good, tasty, healthy food. I used my two "Greens", Cook book most times, and tried recipes from epicurious.com. I also learned about the cook book, "Nourishing Traditions" from my friend Kath. Lobo used epicurious, cooks.com and Sukies Indian spice packs.

Kath, Lobo, and I were always exchanging our left overs. Lobo made curries, I cooked things from the Greens cook book while Kath cooked from Nourishing Traditions. It was great to taste Kath's delicious cooking while opening my eyes to her favorite cookbook. Our friendly food exchanges became regular. Our good friends Niluckshi and Tamiko also joined in the exchange using recipes from Jamie Oliver. We started to drop off food at the school and place the food under our children's coat hooks. Having all this wonderful home cooked food meant more time at the playground with the kids.

A month or so before our return to San Francisco, I asked two good cooks if they wanted to be in a food exchange. Lisa and Jill both said, "yes!" Our first exchange took place on Tuesday September 8 at Rainbow Grocery Store. Jill and I carpooled together with Maya and Pj. The food exchange entres were:
Jill: Polenta and Fish Soup;
Lisa: Veg and Sausage Lasagne
Mari: Cheese and Nut loaf.

The food has been healthy, wholesome, and delicious. A lot of work went into those three dishes and were appreciated by all the families. Maya and PJ are pretty adventurous already and were agreeable to trying food that Jill and Lisa cooked for them.

For the past month Jill and I have been able to exchange dishes once a week, while Lisa exchanges once every two weeks. Jill and I live less than two blocks away from each other so dropping off food on each other's porch is very convenient. We try our best to deliver the food before Tuesday dinner. It has been great to have the refrigerator full of great food. There's definitely extra food which we eat for lunch or give away to our other food friends.

The second week entrees:
Jill - chicken cacciatori
Mari -dahl vegetable stew
Lisa - fresh pasta sauce from her garden

The third week entrees -
Jill - vegatable goulash
Mari's mom's - arroz caldo -

4th week entrees
Jill- green beans and grilled chicken
Lobo chole, chicken curry
Lara (guest cook) lemon risotto

We also had a pot luck on Saturday -
Arielle cooked a nicaraguan dish with masa and chicken
Lobo cooked a lamb curry
Mari: savoury bread pudding with mushrooms and cheese
Lara: Swiss Chard Greens with garlic
Cecile: Chocolate cupcakes with chocolate and caramel ganache- best cupcakes ever
Jill - Lemon Bars - they were perfect

Cooking has become fun and exciting when shared and eaten with friends and family.

Day 8-10 post ACL ..

Had a doctors appointment on thursday. The doc was quite pleased with the progress (and his handiwork) and suggested that I continue pushing hard and learning exercises from the web. He showed me a few new things to try out and I'll incorporate those into my thrice a day PT. (knee bends and hamstring curls)

Have stopped taking all medication (i.e. the tylenol). I'm able to put a fair amount of weight on the knee and can walk around the house without the ace bandage or the immobilizer. I use the cane to provide a wee bit of support if needed. Not having those two things really helps me a lot (since it caused a fair amount of discomfort). I've enlisted the kids to help me with PT. So they press on the knee and count to 20 or so. They also do the leg lifts next to me. So thats kinda fun.

Had a pretty long day outside with mari, lara and the kids yesterday (farmers market, dolores playground, tacubaya and then oakland airport). Was quite exhausted at the end of it. Figured that 3 hours or so outside is my limit before which i need to just lay back and rest for some time. Hopefully this number will go up this week. The food at tacubaya's was quite good. We had the veggie tostada, banana tamales, chicken tostada (for kids), chips and guac and menudo. Would be good to have a place like that in the city. Unfortunately sketch was closed for the second time a row at 5:00 pm. Need to send them mail :( Luckily the kids take it in stride. We had a chocolate cake (with some spicy mexican chocolate sprinkled in there) at tacubaya's instead. Was wolfed down by the kids (and mari and lara) at an amazingly fast rate (i.e. i managed to only get one small spoon!)

Day 6 / 7 after ACL surgery ..

Fortunately day 6 was more like the first few days after the surgery rather than like day 5. Was glad that day 5 was over and done with. Realized that I'm in a bit more pain towards the end of the day, and it might just be the fact that the body is tired etc

Got the PT drills down quite nicely. So doing more reps and for longer periods of time. Realized that the brace and compression bandage are a significant part of the uncomfort, so now I remove them when not needed. It helps that the swelling has reduced significantly. However, this means I need to make sure I have all the stuff needed within easy reach (since putting them on is an exercise by itself). Need to figure out a more efficient moving technique without the brace (crutches?), so i can lie down and stretch as needed.

Had a decent lunch at Shalimar with Lara, Mari and Dave. Being outside and chatting with other folks makes it much easier to deal with (since u r not thinking about the knee etc). Mari and Jill took marley and maya to the asian art museum in the evening. I had the task of entertaining and putting PJ to sleep. We had a small scoop of icecream and walked over to dave's place. They had already left, so PJ was a bit sad and wanted to go to someone else's house to play. We came back home, and spent some time opening the spanish material from la clase divertida. Hopefully their material is better than their customer service (awful, did not respond to email / phone calls). Read a few stories to PJ on her bed and came close to falling asleep there. Had a decent sleep last nite, tossed and turned a bit more than normal.

Having a hard time focussing and sitting for an extended period. So my work productivity is quite awful. However i'm making up by doing customer support and squashing minor bugs in CiviCRM. Hopefully the focus will come back in a few more days

Day 5 (and 6) after surgery ..

so day 5 was probably the most painful day of all so far. Not very sure why, but might have been due to my "long" walk on day 4 (which had a decent downhill component). Anyway got up at 3:00 am and was quite uncomfortable (bordering on pain, i think) till 6:30 am. I finally asked mari to help me take a shower with the hope of improving things. It did help a bit but not a lot. I also removed both the support and compression bandage for an hour or so and that seemed to help a lot.

The rest of the day was quite similar. Was not really a happy person yesterday. We went to Phu and Tamar's house in Portola valley after school today. The kids had a good time especially when the sprinklers came on. I started hurting a bit towards the latter part and we hurried back home.

Had a great sleep last nite (removed the compression bandage also). Maybe it was a combination of lack of sleep and the wine etc, but things look real good and up today. The pain has decreased considerably and hopefully things will be better from here on out .... Its amazing how different your mood/attitude is after a good sleep :)

Have been doing a fair amout of physical therapy. Do a set of exercises approx 3 times a day (ankle streches, leg lifts and knee bends). So far things are looking good on that front.